Course Content

Vitamin B12 deficiency is common, often neglected, relevant to the majority of patients with Parkinsonism, and if not discovered and treated early, can be neurologically devastating

B12 deficiency is a commonly overlooked cause of parkinsonism. B12 deficiency should be ruled out in every person as part of the diagnostic work-up; a serum B12 levels is NOT sufficient to rule out a B12 deficiency.

Age, stress, levodopa, and a handful of other medications and insults interfere with the body's ability to absorb B12. Most people need to take their B12 under the tongue or as a shot in their muscles.

This live discussion will describe the tests that determine whether you're B12 deficient or not, and what to do about it if you are.

Multiple Paths to Elevated Homocysteine

There are a variety of ways that a person with Parkinson's may find themselves with elevated homocysteine, some related to PD, some not.

Cobalt Deficiency Often Overlooked

Without cobalt, homocysteine is not functional. Hair provides a cheap, easy screening test for cobalt status. In clinical practice, I've seen low hair cobalt occur 2 years before evidence of deficiency in blood.

How Best to Test

To rule out a vitamin B12 deficiency in the presence of any neurological or psychological symptom(s), the following tests are needed:

  • serum B12 > 700
  • homoycsteine < 10
  • methylmalonic acid < 300
  • hair cobalt within 1 SD
  • MCV <98
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B12 Shots are Often Necessary

The primary cause of B12 deficiency is due to the stomach losing its ability to absorb B12. Thus, to get B12, we need to bypass the gut. Sometimes sublingual (under the tongue) B12 works, but intramuscular B12 shots are frequently necessary.

Homocysteine is a Metabolotoxin

While a little bit of homocysteine in the system is normal, when levels get too high (~ >15), homocysteine begins to behave as a neurotoxin.

High homocysteine is associated with faster PD progression and increased risk of dementia.

Dr. Laurie K Mischley

Dr. Mischley has spent the past two decades studying the unique nutritional requirements of people with Parkinsonism and working to find better ways to measure, monitor, predict, and prevent PD.

Her academic training is in naturopathic medicine (ND), nutrition (BS, PhD), and epidemiology (MPH). She created the PRO-PD outcome measure, built the Parkinson Symptom Tracking App (, has trained dogs to detect the scent of parkinism in ear wax (, is lead investigator of the, and is founder of the Parkinson Center for Pragmatic Research (CPR). She created in 2020 as a way to empower patients, accelerate education and catalyze some long-overdue conversations.

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